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Using AM-PAC for Claims-Based Outcomes Reporting
Michael Stevenson, MBA, PT Director, Product Management
Industry Landscape
CBOR (High Level)
Boston University Activity Measure for Post Acute Care (AM-PAC)
Demonstration
Non-MediServe clients
MediServe clients
Reporting / Data Management
Pricing Models
Resources
Objectives
2
Submit in the Questions Tab!
Rehabilitation
IP, OP, IRF, PP
Respiratory
250+ Clients
Chandler, Arizona
CORE Focus
(Compliance, Outcomes, Revenue, Efficiency)
MediServe
4
More than 25 Years Serving the Rehab and Respiratory Communities
A Few of Our Clients
5
What Brought Us Here?
CMS Landscape
Between 1998–2008, Medicare expenditures for outpatient therapy services increased at a rate of 10.1 percent per year while the number of Medicare beneficiaries receiving therapy services only increased by 2.9 percent per year.
CMS Landscape
PAC-PRD
CMS funded, multi-year
RTI
CARE Parts A,D,I,E
Limited to using existing instruments(IRFPAI, MDS, OASIS)
Tool is a collection of validate measures across PAC except HH
DOTPA
CMS funded, multi-year
RTI
CARE Part C,F
Can use new instruments
Patient Self Assessment AM-PAC, NOMS, SF-36
Sections for PT, OT, SP ICF-based assessments
13 DOTPA references in final rule
CMS Landscape
STATS
The CY 2013 proposal was based upon an option for claims-based data collection that was developed as part of the Short Term Alternatives for Therapy Services (STATS) project under a contract with CMS, which provided three options for alternatives to the therapy caps that could be considered in the short-term before completion of the DOTPA project.
Section 3005(g) of the MCTRJCA requires CMS to implement, beginning on January 1, 2013,
“. . . a claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services subject to the limitations of section 1833(g) of the Act. Such strategy shall be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes.”
The Other Shoe Has Dropped
CBOR: What is it?
http://www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdf
Page 68958-68978
Federal Register
Who Is Impacted
Medicare Part B
All areas of outpatient therapy services including hospitals, CAH, CORF, private practice, home health (after A benefit), SNF, etc.
As we explained in the proposed rule, this broad applicability would include therapy services furnished in hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), CORFs, rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians and NPPs.
Test Phase Begins
January 1, 2013
Required Submission
July 1, 2013
Payment Rejection beginning July 1, 2013
When Does It Happen
We are finalizing an implementation date of January 1, 2013 with a 6-month testing period such that claims that do not comply with the data reporting requirements will be returned beginning July 1, 2013.
14 new G-codes sets
11 Functional G-codes (7 of those SLP)
3 ‘other functional area’, one for each discipline
7 Impairment Limitation Restriction Modifiers
Must use Outcomes Measures that map to a 7 point scale
AM-PAC, FOTO, OPTIMAL, NOMS recommended by CMS in IOM
IOM provision of the Benefits Policy Manual, Chapter 15, Section 220.3C “Documentation Requirements for Therapy Services.”
How It Works
PAC Metrix and CBOR
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PAC-Metrix is MediServe’s web-based AM-PAC Assessment instrument
CMS lists the AMPAC as one of 4 named NQF endorsed outcomes tools which will satisfy the outcomes reporting required in 2013
MediServe has customized PAC-Metrix to support the unique workflow needed to submit G-codes with modifiers to CMS
PAC-Metrix meets CMS’ Requirements
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www.pac-metrix.com
AMPAC: Activity Measure for Post Acute Care The AMPAC was developed as a functional outcomes system that can be used across post-acute care settings
Consists of a comprehensive list of 269 functional activities It measures functional outcome by using contemporary measurement techniques, such as Item Response Theory (IRT) and Computer Adaptive Testing (CAT)
The AMPAC was designed to be used across patient diagnoses, conditions and settings where post-acute care is being provided
What is the AMPAC?
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More than CBOR!!!
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The AMPAC assesses Outcomes from the perspective of… THE PATIENT
By answering functional question of varying levels, the patient’s functional status can be measured
In situations where the patient cannot effectively self-assess, the use of a proxy is indicated
Patient-Centric Outcomes
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Andres PL, Haley SM, Ni P. Is patient-reported function reliable for monitoring post-acute outcomes? Am J Phys Med Rehabil. 2003 Aug; 82(8):614-21.
Haley SM, Ni P, Coster WJ, Black-Schaffer R, Siebens H, Tao W. Agreement in functional assessment: graphic approaches to displaying respondent effects. Am J Phys Med Rehabil. 2006; 85(9):747-55.
Activity Limitations – which are a sub-component of Disabilities
Using the World Heath Organization definition, an activity limitation is defined as “difficulty encountered by an individual in executing a task or action”
Difficulty performing a task
Assistance required to perform a task
Limitations when performing a task.
What Is Being Assessed?
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http://www.who.int/topics/disabilities/en/
•Computer Adaptive Testing (CAT) dramatically reduces test load over paper instruments
•Assessment tool determines the most relevant question to ask next based on previous Q/A
•Unique path through Item bank of 261 items
•Minimum 5 – Maximum 10 questions per domain
• Stop when Standard Error < 2
eCAT
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Haley SM, Ni P, Hambleton RK, Slavin MD, Jette AM.
Computer adaptive testing improves accuracy and
precision of scores over random item selection in a
physical functioning item bank. J Clin Epidemiol.
2006; 59: 1174-1182.
Basic Mobility … Daily Activity … Applied Cognitive
•The mix of domains assessed depends on the reason for treatment:
•Major Medical: BM, DA, AC
•Cardiac: BM, DA, AC
•Neurologic: BM, DA, AC
•Ortho – LE: BM
•Ortho – UE: DA
•Ortho – Spine: BM, DA
Domains
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Haley SM, Coster WJ, Andres PL, Ludlow LH, Bond T,
Sinclair SJ, Jette AM.
Activity Outcome Measurement for Post-acute Care.
Medical Care. 2004; 42(1 Suppl):I49-I69.
G-Code Domain Mapping
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AMPAC Domain Functional Area
Basic Mobility Mobility: Walking & Moving Around
Basic Mobility Changing & Maintaining Body Position
Basic Mobility Carrying, Moving & Handling Objects
Daily Activity Self Care
Applied Cognitive
Communication, Understanding Complex Instructions, and Use of Print and Other Materials
Modifier Basic Mobility Daily Activity
Applied
Cognitive
Impairment Limitation
Restriction Difficulty
CH 104.9 115.4 68.28 0%
CI >81.53 >91.77 >53.25 <20%
CJ >58.16 >68.15 >38.23 <40%
CK >34.79 >44.52 >23.21 <60%
CL >11.42 >20.9 >8.18 <80%
CM >-11.95 >-2.73 >-6.84 <100%
CN -11.95 -2.73 -6.84 100%
G-Code Modifiers – Goal Setting
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Modifier ranges calculated by Dr. Allan Jette by determining the thresholds based on the national AMPAC database
Stages for Patients
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Does not apply to MediLinks users
PAC Metrix Workflow
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STAFF Patient Registration
PATIENT Take Assessment
MediLinks Users
PAC Metrix Only
Patient Experience
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OR
• Once an assessment has been completed several options exist to use the data...
Managing Data & Reports
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Managing Data in MediLinks
AMPAC Reporting in MediLinks
Managing Data in PAC-Metrix
AMPAC Reporting in PAC-Metrix
Managing Patient Data in PAC-Metrix
34 Return
Managing Patient Data in PAC-Metrix
35 Return
Managing Patient Data in PAC-Metrix
36 Return
PAC Metrix Reports Improvement: Facility and Admit Date
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Site Name
PAC Metrix Reports Improvement: Facility & Financial Class
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Site Name
PAC Metrix Reports Improvement: Facility & Impairment
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Site Name
•AMPAC Data eventually must come to MediLinks
•The assessment tool does not store the data in a patient episode
•Putting the data in MediLinks supports an integrated reporting solution
•The Assessment Report printed at the end of the assessment contains the necessary assessment information
MediLinks & AMPAC
40 Return
AMPAC Data in MediLinks
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The AMPAC MDS includes some basic information about the patient themselves. Additionally, the scores can be entered in a dedicated grid/branch or in a combined score & demographics option MediLinks allows both a Grid and a Branching Logic entry mechanism • “Initial” refers to the
admission assessment • “Follow-up” refers any
assessment after the admission assessment
• Optionally a target (goal) value can be set and is displayed
Return
MediServe currently provides 6 standard reports to extract data out of MediLinks
•Some reports may need to be tuned to your configuration: • Assessment Dashboard
• Assessments Completed
• No Recent Assessments
• Only Initial Assessments Completed
• Assessments Improvement
• Charges & Outcomes
As more are developed, you will receive updates
AMPAC Reports in MediLinks
42 Return
AMPAC Reports in MediLinks
43 Return
AMPAC Reports in MediLinks
44 Return
AMPAC Reports in MediLinks
45 Return
•Will patients conduct the initial assessment before/during/after the first appointment?
•Will the assessment be unattended on a public kiosk, or done with the therapist/tech on a laptop?
•How directive can/will the front desk be in this process?
•Where is the printer for the computer?
•How will the information get to the Therapist?
AMPAC Workflow Questions
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Phases of AMPAC Deployment
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Adoption
Baseline
Analysis
Adapt
1-3 Months
4-6 Months
1-2 Months
Ongoing
Staff learns new workflow and develops confidence/competence with the tool
Data is consistently collected and establishes the baseline for outcomes for the facilities
Based on the data collected, patterns are analyzed and trends (good and bad) are identified
Changes are made based on the analysis performed to determine if outcomes can be improved, standardized or repeated
Outcomes are part of a continued commitment to improvement
Annual Subscription
Episode Based
~$2 per new patient
Unlimited assessments per patient
Per Location, volume adjusted
No Implementation Fee
Easy set up, user manual
Pricing
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www.mediserve.com/cbor
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PAC-Metrix.com
“Try it Out’’
QUESTIONS?
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